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ELECTRICAL PERMIT APPLICATIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25i-8810 - FAX 425-257-8857-www everettwa.org <br /> /o ` �`� ��3 <br /> �ZS t,..�� ���f� � ���a -ll�/ <br /> PROJECTADDRESS <br /> � 1� a��- ��� �1 � ���3 ����sa� <br /> Owner R7atlAddress Cny Slate/Zip Phone <br /> Tenan� 1,7ai1 Atldress City SlatelZip Phone I <br /> ��-��Ct� �-t`�-IyU �- C�-+�!-!n"'#�.1� U� A�,�1 l U..E- �x.�A-�S3Z��7 r 2� S�1 � <br /> Ele[�riCalContraCtor �dailAdaress Ciry Sta;e/Zip Phone <br /> �S.�i�r�a �� P�L _3200 ' <br /> State License Number � Contract Price of Woik <br /> 2F+S\ I,�J�*'1A�-- <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Squam Footage pf residertial new construction,remodel or add.,.�n) <br /> Numbcr of devices(I11ow voltaye) <br /> Description o(Work�o De Done: 1�,Y�L-�rC Z�t3�\ �.[��� <br /> FEE ', ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �' 1t��, <br /> I hereby certily thaf I have read and examineJ Ihis application and know(he sarne(o be Wo and ` <br /> correc(. All pmvisions o/la�vs and ortiinances goveming fhis type o/ta-odc�vill be completed <br /> whelher specified hemin or noL The granfing ol a penni(does nol presume to givc aulhonty lo PERMIT# <br /> violafe or cancel(he provisions o/any other slate or local!mv iegulaling cons(ruction or(he �I� ' <br /> ped�rmance o/consWc�ion. That I am aufhonzed by fhe owner of(his propedy ro peAorm Ihe E t ��O <br /> i � work/or whidi,�pplica(ion is made and I comply with fhe Sfate Con(raclors Law 78.27 RCW and � <br /> 296.200 W <br /> �o t5 13 <br /> Signatu alc �'� <br /> REV�S[OY.'0.'I] � <br />